Mending Bodies, Saving Souls: A History of Hospitals, by Guenter B. Risse
Hospitals, like many of society’s most vital institutions, have deep Christian roots that are often overlooked today. Guenter B. Risse’s Mending Bodies, Saving Souls: A History of Hospitals explores this history, and while it was a challenging read, it offered valuable insights into how Christians shaped medical care throughout the centuries.
The idea was recently brought to me to consider writing articles about some of the books I’ve read. I thought this was a great idea for two reasons. First, it introduces our church to books they might want to read. Second, some of the books I’ve read, many people would not want to read. So, it might actually be helpful if I saved others the time and condensed the main ideas into an article.
Many of the pillars of our society came as the fruit of Christian charity and sacrifice but have now been taken over by either the government or secular leadership.
Guenter B. Risse’s Mending Bodies, Saving Souls: A History of Hospitals is a good example of this second reason. It took me about nine months to slog through, and, while I’m glad I put the work in, I’m not sure I would recommend it to others.
I’d had this book on my shelf for several years and had made it a goal of my summer sabbatical to crack into it. My interest in the history of medicine comes from my interest in the institutions historically built by Christians. I knew that hospitals were a Christian invention, but I wanted to know the details of their development. Many of the pillars of our society came as the fruit of Christian charity and sacrifice but have now been taken over by either the government or secular leadership.
Many Christians in our day believe the medical establishment needs disruption just as much as the educational establishment.
Because of that, many people have become disenchanted with some of the core institutions of our society. Education is an example of this, which is why our church has been involved in the classical education renaissance. At the same time, many Christians in our day believe the medical establishment needs disruption just as much as the educational establishment.
Reading Bisse’s treatment of medical history convinced me that this is something Christians really need to think about. Jesus came to earth, and his ministry largely looked like teaching people’s minds and healing their bodies. It is no wonder that, for centuries, schools and hospitals have been two of the key institutions created by Christians and the church.
While reading this book, I actually started playing tennis with one of the former finance directors from St. Joe’s here in Bellingham (he later became the CEO of Peace Health Ketchikan, AK). He told me how he could see the gradual transition over the course of his career: more hospitals quit being religious ministries of compassion and became profit-seeking businesses. It surprised me that as recently as the 1980s, Peace Health had Roman Catholic nuns serving as CEOs.
The profoundly religious heritage of hospitals came through in Mending Bodies, Saving Souls. I gleaned many insights, but I’d like to highlight four that struck me the most.
1. The early church built institutions for caring for the sick.
One of the primary reasons I wanted to read this book was to learn more about the church fathers and the institutions they built to care for the poor. I had known about Basil of Caesarea and the “new city” he built in the outskirts of the city in the 4th century. (We visited Basil’s church and monastery this past summer in Turkey.) His friend Gregory of Nazianzen, another Cappadocian father, said, “[The city was] a storehouse of piety … there, sickness is endured with equanimity, calamity is a blessing, and sympathy is put to the test.”
Called the Basileiados, this new city had a church, a residence for the administrator, and quarters for subordinate assistants. It was a religious spiritual center as well as a medical institution, and many would say it was the world’s first hospital.
Basil’s vision represented the conviction of the early church that it was their responsibility to build institutions that fulfilled Jesus’ instructions to them in the Gospels. In Jesus’ famous description of the final judgment, he said there would be six merciful acts he would judge the church upon:
I was hungry and you gave me food
I was thirsty and you gave me drink
I was a stranger and you welcomed me
I was naked and you clothed me
I was sick and you visited me
I was in prison and you came to me
Throughout the first millennium of the church, God’s people saw that a huge part of their mission was to organize themselves to do these six acts effectively. Hospitals basically exist because of the seriousness with which Christians took the visitation and care of the sick.
This inspired me to think about our own church. What if we took these as our institutional goals as well—that Jesus would return and find that we had done these six things?
This pattern of institutional care for the sick continued beyond antiquity and into the Middle Ages, thanks largely to Benedictine monasteries. These monasteries were places of spiritual respite, hospitality, and care for the hurting. Monks were skilled healers, and the monasteries were the primary centers for medical care throughout Europe. The monks transmitted medical knowledge through books which they copied copiously, especially during the Charolingian cultural revolution of the ninth century. By the eleventh and twelfth centuries, the church had formalized the responsibilities of not just clergy, but even of lay people in building communities that fulfilled Jesus’ six calls for mercy.
2. There has always been skepticism about whether medical establishments are places of healing or harm.
As medical practice developed over the course of the medieval period, the role of hospitals became less clear. Whereas in antiquity they were clearly places of healing, in the medieval period they also became places of segregation and confinement. For example, one primary purpose of hospitals was to house lepers. This practice of confinement began a reputation among hospitals that persisted for centuries, even into the modern era—that hospitals are places of contagion and sickness. They are not places where you go to be healed but where you go to die. This was true even as hospitals entered into the age of the Enlightenment.
Despite these and other regressions, overall the hospital movement saw steady and positive reform. Bisse notes that entering the early modern era
The British hospital movement shared its values and organizing principles with those of other contemporary reforms, including charity schools, orphanages, workhouses, and prisons … As before, the religious roots went back to Matthew’s injunctions in the Scriptures to visit the sick. The performance of charitable good works was compatible with Anglican as well as Calvinistic theology, involving bishops, ministers, elders, and parish members. Drawing on time-honored models, infirmaries were places ‘to reclaim the souls of the sick’ while caring for their bodily ills.” (p. 237)
Here we see ministry to the whole person, body and soul.
As noble as the motivations were for caring for the sick, the new scientific approaches had a lot to learn about the human body and health. Entering into any kind of work like this will inevitably involve missteps and failures. Just imagine the harm you are surely going to cause many people when you start experimenting with cutting into their bodies. But there would be no advancement if people were not willing to have the courage to explore the mysteries of science.
Of course, many of the medical errors came from ignorance. Before the development of germ theory, hospitals largely thought ventilation was the primary solution to the spread of disease. But upon learning that what actually causes disease is micro-organisms, cleanliness and sanitation became a much higher priority. It is easy to look back and think how foolish previous generations were, but later generations will look back on us the same way.
Much of this reminded me of the current disruption in medicine happening in our day. Many critics are saying that our medical establishment is actually incentivized to keep people chronically ill, which is one reason why our society is so unhealthy. It makes people question if medical institutions are places of healing or harm. Both pharmaceutical and insurance companies have their primary revenue coming from medications for sick people. If people are healthy, these companies lose their profits. The history of hospitals taught me that the medical community has always received criticism from the public. It may feel unfair to those working so hard to care for their communities, but it is very likely these criticisms have helped push medical development and progress. I imagine that could be frustrating for medical professionals who, more often than not, really do care about people and want to help them. But I believe a new era of medical development will happen within our generation because of these critiques.
3. Pious women played an important role in the development of hospitals.
It also struck me how much the administrative gifts of women played an important role in the efficacy of modern hospitals.
Among both Catholic and Protestant orders of women administrators and nurses, there was a high expectation of piety, order, discipline, knowledge, and skill. One exceptional example is Madame Necker, who founded the Necker Hospital (still in existence) in Paris in 1778. Though a Protestant, she contracted the Sisters of Charity, who largely ran the institution—hiring and firing lay servants, running the institutional pharmacy, and performing most caregiving functions. This hospital became a model for modern hospitals in the years that followed.
But even more influential is the famous Florence Nightingale. She developed a training program for nurses that became the model for hospitals around the world. Her philosophy was developed in her time serving in the Crimean war, bringing order to the horrific infirmaries where soldiers suffered miserably. She also went to learn from the Sisters of Charity in Paris and the Protestant Deaconess Institute in Germany. “Other critical Victorian attributes were the Nightingales’ presumed moral qualities and character. These were seen as essential in preserving the hospital’s traditional spiritual care function, now increasingly displaced by newer medical agendas” (p. 371).
The historic influence of these women wasn’t because of a feminist bent. This past summer I read a biography of Queen Victoria (a contemporary and friend of Nightingale) when we were in London visiting Buckingham palace. Queen Victoria may be the most honored monarch in British history, as the giant statue of her in front of the palace attests. She reigned over the largest empire in human history during the nineteenth century.
What seems to me to be one of the biggest problems with modern medicine is the way it views human persons. It does not view us as the union of the spiritual and the physical.
Victoria admired and had a friendship with Florence Nightingale, and her biographer makes a point that both of these women resisted the early trends of feminism. Though Victoria was the monarch and her husband Albert was simply a prince, she still insisted to “obey” him in her wedding vows, and she despised women who dominated their husbands. Victoria described Nightingale this way: “Her mind is solely and entirely taken up with the one object to which she has sacrificed her health and devoted herself like a saint. But she is entirely free of absurd enthusiasm … truly simple, quiet, pious in her actions and views, yet without the slightest display of religion or a particle of humbug” (Baird, p. 275). Nightingale certainly fought for women to be more challenged intellectually, and she enjoyed stimulating conversation. She also opened professional doors for women in the medical world. But she did not support women’s suffrage and embraced a submissive role for women. (I’m not saying that women’s suffrage was wrong, only that Nightingale did not fall into our paradigms of feminism like we might assume she would. She is a more interesting and complex figure.)
I know that our late modern sensibilities find these views offensive. But these were two of the most remarkable women in history—and they didn’t need to be feminists to be so. They were both pious, read their Bibles every day, and served people with single-mindedness.
It is also worth noting that the most significant advances in surgery, transplantation, and other medical techniques (like antiseptic and anesthesia) were developed by men. The story of medicine confirms with the rest of history that men and women are made differently by God, but together make essential contributions to the development of human progress. I believe our church has to recognize and celebrate the gifts God has given to our wise and pious women while at the same time resisting the pride and resentment that have powered the feminist movement. If the church is to reclaim its heritage in the healing arts, it will be done with the cooperative work of gifted men and women together in the church.
4. Until recently, medical care was holistic; spiritual care and physical care were deeply intertwined.
What seems to me to be one of the biggest problems with modern medicine is the way it views human persons. It does not view us as the union of the spiritual and the physical. It does not recognize how deeply connected spiritual and moral health is to physical and emotional health.
After 2000 years of Christians caring for the sick, it is fair to say that this de-spiritualizing of people is a recent innovation. Especially the Catholic hospital system has faced major challenges in adapting to the modern world. But what they had built at various times was a beautiful reflection of the liturgical city of God described in the book of Revelation, where the trees of the city are for the “healing of the nations.”
I was inspired by the description of Mercy Hospital in Buffalo, NY during the 1950s:
[S]piritual well-being was a priority. Sisters used a religion rich in rituals and ceremonies to re-create in the hospital a daily and weekly rhythm of life that aimed to provide meaning to suffering and promote healing. The hospital had a beautiful chapel, walled in white marble, with an ample balcony and a capacity for 200 worshippers. This church was at the center of hospital life, a place for quiet meditation prayer, where mass was celebrated daily and graduation ceremonies for the nurses took place. Early each morning, caregivers and ambulatory patients received the Eucharist, the traditional celebratory meal. For those unable to attend, the day began at 7am with a three-minute morning prayer coming over the hospital’s loudspeaker. The Angelus, a blessing before the meal, was also heard at noon and at 6pm throughout the hospital. The day ended with another prayer at 9pm. Sunday mass was also transmitted over a number of speakers (p. 528).
This kind of holistic care of people is something greatly lost in our day. A hospital like this seems almost unimaginable to Christians in America of the 21st century. But we have a heritage as healers. Just as we need to reclaim our heritage of education (Christ is the great Teacher), the church needs to reclaim her heritage of medicine (Christ is the great Healer). Whether our church is to be part of this, only the Lord knows. But we need to begin by believing that Jesus came teaching and healing, and we need to begin reimagining what Christian medicine looks like. We should at least long to see the healing ministry of Jesus Christ reclaimed in our land.
